Disorders - Suicide or self-harm behaviours
Gould, M. S., Greenberg, T., Velting, D. M., Shaffer, D.
Objective: To review critically the past 10 years of research on youth suicide. Method: Research literature on youth suicide was reviewed following a systematic search of PsycINFOand Medline. The search for school-based suicide prevention programs was expanded using two education databases: ERIC and Education Full Text. Finally, manual reviews of articles' reference lists identified additional studies. The review focuses on epidemiology, risk factors, prevention strategies, and treatment protocols. Results: There has been a dramatic decrease in the youth suicide rate during the past decade. Although a number of factors have been posited for the decline, one of the more plausible ones appears to be the increase in antidepressants being prescribed for adolescents during this period. Youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms are key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Promising prevention strategies, including school-based skills training for students, screening for at-risk youths, education of primary care physicians, media education, and lethal-means restriction, need continuing evaluation studies. Dialectical behavior therapy, cognitive-behavioral therapy, and treatment with antidepressants have been identified as promising treatments but have not yet been tested in a randomized clinical trial of youth suicide. Conclusions: While tremendous strides have been made in our understanding of who is at risk for suicide, it is incumbent upon future research efforts to focus on the development and evaluation of empirically based suicide prevention and treatment protocols.
Journal of the American Academy of Child & Adolescent Psychiatry., 42(4) : 386-405
- Year: 2003
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
, Universal prevention
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Treatment and intervention: Psychological Interventions (any)
Power, P. J. R., Bell, R. J., Mills, R., Herman-Doig, T., Davern, M., Henry, L., Yuen, H. P., Khademy-Deljo, A., McGorry, P. D.
Background: Young people with early psychosis are at particularly high risk of suicide. However, there is evidence that early intervention can reduce this risk. Despite these advances, first episode psychosis patients attending these new services still remain at risk. To address this concern, a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre (EPPIC). The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy (LifeSPAN therapy) for acutely suicidal patients with psychosis. We describe the development of these interventions in this paper. Method: Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC. Second, staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service. Third, a suicide risk monitoring system was introduced to identify those at highest risk. Finally, patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a randomised controlled trial. Results: Fifty-six suicidal patients with first episode psychosis were randomly assigned to standard clinical care or standard care plus LifeSPAN therapy. Forty-two patients completed the intervention. Clinical ratings and measures of suicidality and risk were assessed before, immediately after the intervention, and 6 months later. Benefits were noted in the treatment group on indirect measures of suicidality, e.g., hopelessness. The treatment group showed a greater average improvement (though not significant) on a measure of suicide ideation. Conclusions: Early intervention in psychosis for young people reduces the risk of suicide. Augmenting early intervention with a suicide preventative therapy may further reduce this risk.
Australian & New Zealand Journal of Psychiatry., 37(4) : 414-420
- Year: 2003
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Kovac, S. H., Range, L. M.
To assess whether writing with cognitive change or exposure instructions reduces depression or suicidality, 121 undergraduates screened for suicidality wrote for 20 minutes on 4 days over 2 weeks. They were randomly assigned to reinterpret or to write and rewrite traumatic events/emotions, or to write about innocuous topics. The three groups (N= 98) who completed pre-, post-, and 6-week follow-up were not different on suicidality or depression. All subjects reported fewer automatic negative thoughts over the 2 weeks; they also reported higher self-regard but more health center visits at follow-up. Suicidal thoughts may be more resistant than physical health to writing interventions.
Suicide & Life-Threatening Behavior., 32(4) : 428-440
- Year: 2002
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Creative expression: music, dance, drama, art
Rathus, Jill H., Miller, Alec L.
We report a quasi-experimental investigation of an adaptation of Dialectical Behavior Therapy (DBT) with a group of suicidal adolescents with borderline personality features. The DBT group (n = 29) received 12 weeks of twice weekly therapy consisting of individual therapy and a multifamily skills training group. The treatment as usual (TAU) group (n = 82) received 12 weeks of twice weekly supportive-psychodynamic individual therapy plus weekly family therapy. Despite more severe pre-treatment symptomatology in the DBT group, at post-treatment this group had significantly fewer psychiatric hospitalizations during treatment, and a significantly higher rate of treatment completion than the TAU group. There were no significant differences in the number of suicide attempts made during treatment. Examining pre-post change within the DBT group, there were significant reductions in suicidal ideation, general psychiatric symptoms, and symptoms of borderline personality. DBT appears to be a promising treatment for suicidal adolescents with borderline personality characteristics.
Suicide & Life-Threatening Behavior, 32(2) : 146-57
- Year: 2002
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Dialectical behavioural therapy (DBT)
Greenfield, B., Larson, C., Hechtman, L., Rousseau, C., Platt, R.
Objective: The authors studied the clinical outcomes of suicidal adolescents who were treated within a rapid-response outpatient model in a setting in which a ten-day wait was usually required before outpatient treatment could be started, leaving hospitalization as the only immediately available alternative. Methods: A total of 286 suicidal adolescents aged 12 to 17 years who came to the emergency department of a pediatric hospital were assigned to receive rapid-response outpatient follow-up (the experimental group) or to a control group. Demographic and clinical data were obtained at baseline, and outcomes data were obtained at two and six months. Results: The demographic and clinical characteristics of the two groups were similar at baseline. Hospitalization rates in the experimental and control groups, respectively, were 10 percent and 40 percent at baseline, 17 percent and 41 percent at two-month follow-up, and 18 percent and 43 percent at six-month follow-up, corresponding to a relative risk of hospitalization of .41 in the experimental group at six months. No between-group differences were observed in changes in levels of suicidality or in overall functioning over the follow-up period, and none of the patients had died at six months. Conclusions: Suicidal adolescents who received rapid-response outpatient follow-up had a lower hospitalization rate than those who did not. The two groups achieved similar increases in levels of functioning and decrease in levels of suicidality, suggesting that suicidal adolescents can be treated within a rapid-response outpatient model and thus avoid hospitalization.
Psychiatric Services., 53(12) : 1574-1579
- Year: 2002
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Eggert, Leona L., Thompson, Elaine A., Randell, Brooke P., Pike, Kenneth C.
PROBLEM: Few empirically tested, school-based, suicide-prevention programs exist. The purpose of this study was to evaluate the postintervention efficacy of Counselors-CARE (C-CAST) and Coping and Support Training (CAST) vs. "usual care" controls for reducing suicide risk. METHODS: A randomized prevention trial; 341 potential dropouts, 14 to 19 years old, from seven high schools (52% female, 56% minorities) participated. Trend analyses using data from three time points assessed over time changes. FINDINGS: Significant decreases occurred for all youth in suicide-risk behaviors, depression, and drug involvement. Intervention-specific effects occurred for decreases in depression. CONCLUSIONS: School-based prevention approaches are feasible and show promise for reducing suicidal behaviors and related depression.
Journal of Child & Adolescent Psychiatric Nursing, 15(2) : 48-64
- Year: 2002
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Joiner-Jr, Thomas E., Voelz, Zachary R., Rudd, M.
Practicing psychologists face many complexities and challenges in caring for suicidal patients who have comorbid mood and anxiety disorders. Not only must suicidal crises be addressed, but co-occurring depressive and anxiety symptoms compete for attention as well and are associated with relatively poor clinical prognosis in usual treatments. The current study compared problem-solving treatment to treatment as usual among depression-anxiety comorbid versus noncomorbid clinically suicidal young adults. Suicidal patients with mood and anxiety disorders were randomized to the 2 treatments and followed over time. Comorbid suicidal patients, in particular, experienced notable symptom improvements from the problem-solving treatment. Features of the problem-solving treatment are described for use in clinical practice. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Professional Psychology: Research & Practice, 32(3) : 278-282
- Year: 2001
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Problem solving therapy (PST)
Randell, B. P., Eggert, L. L., Pike, K. C.
This study evaluated the immediate postintervention effects of two brief suicide prevention protocols: a brief interview - Counselors CARE (C-CARE) - and C-CARE plus a 12-session Coping and Support Training (CAST) peer-group intervention. Subjects were students "at risk" of high school dropout and suicide potential in Grades 9-12 from seven high schools (N = 341). Students were assigned randomly to C-CARE plus CAST, C-CARE only, or "intervention as usual." The predicted patterns of change were assessed using trend analyses on data available from three repeated measures. C-CARE and CAST led to increases in personal control, problem-solving coping, and perceived family support. Both C-CARE plus CAST and C-CARE only led to decreases in depression, and to enhanced self-esteem and family goals met. All three groups showed equivalent decreases in suicide risk behaviors, anger control problems, and family distress.
Suicide & Life-Threatening Behavior., 31(1) : 41-61
- Year: 2001
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Skills training, Other Psychological Interventions
Wood, A., Trainor, G., Rothwell, J., Moore, A., Harrington, R.
Objective: To compare group therapy with routine care in adolescents who had deliberately harmed themselves on at least two occasions within a year. Method: Single-blind pilot study with two randomized parallel groups that took place in Manchester, England. Sixty-three adolescents aged 12 through 16 years were randomly assigned to group therapy and routine care or routine care alone. Outcome data on suicide attempts were obtained without knowledge of treatment allocation on all randomized cases (62/63 by direct interview) on average 29 weeks later. The primary outcomes were depression and suicidal behavior. Results: In intention-to-treat analyses, adolescents who had group therapy were less likely to be "repeaters" at the end of the study (i.e., to have repeated deliberate self-harm on two or more further occasions) than adolescents who had routine care (2/32 versus 10/31; odds ratio 6.3), but the confidence intervals for this ratio were wide (95% confidence interval 1.4 to 28.7). They were also less likely to use routine care, had better school attendance, and had a lower rate of behavioral disorder than adolescents given routine care alone. The interventions did not differ, however, in their effects on depression or global outcome. Conclusions: Group therapy shows promise as a treatment for adolescents who repeatedly harm themselves, but larger studies are required to assess more accurately the efficacy of this intervention.
Journal of the American Academy of Child & Adolescent Psychiatry., 40(11) : 1246-1253
- Year: 2001
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Thompson, E. A., Eggert, L. L., Randell, B. P., Pike, K. C.
Objectives. This study evaluated the efficacy of 2 indicated preventive interventions, postintervention and at 9-month follow-up. Methods. Drawn from a pool of potential high school dropouts, 460 youths were identified as being at risk for suicide and participated in 1 of 3 conditions randomly assigned by school: (1) Counselors Care (C-CARE) (n = 150), a brief one-to-one assessment and crisis intervention; (2) Coping and Support Training (CAST) (n = 155), a small-group skills-building and social support intervention delivered with C-CARE; and (3) usual-care control (n = 155). Survey instruments were administered pre-intervention, following C-CARE (4 weeks), following CAST (10 weeks), and at a 9-month follow-up. Results. Growth curve analyses showed significant rates of decline in attitude toward suicide and suicidal ideation associated with the experimental interventions. C-CARE and CAST, compared with usual care, also were effective in reducing depression and hopelessness. Among females, reductions in anxiety and anger were greater in response to the experimental programs. Cast was most effective in enhancing and sustaining personal control and problem-solving coping for males and females. Conclusions. School-based, indicated prevention approaches are feasible and effective for reducing suicidal behaviors and related emotional distress and for enhancing protective factors.
American Journal of Public Health., 91(5) : 742-752
- Year: 2001
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Skills training, Other Psychological Interventions
Rotheram-Borus MJ, Piacentini J, Cantwell C, Belin T. R, Song J
Following a suicide attempt by female adolescents, the impact of a specialized emergency room (ER) care intervention was evaluated over the subsequent 18 months. Using a quasi-experimental design, this study assigned 140 female adolescent suicide attempters (SA), ages 12-18 years, and their mothers (88% Hispanic) to receive during their ER visit either: (a) specialized ER care aimed at enhancing adherence to outpatient therapy by providing a soap opera video regarding suicidality, a family therapy session, and staff training; or (b) standard ER care. The adjustment of the SA and their mothers was evaluated over 18 months (follow-up, 92%) using linear mixed model regression analyses. SA's adjustment improved over time on most mental health indices. Rates of suicide reattempts (12.4%) and suicidal reideation (29.8%) were lower than anticipated and similar across ER conditions. The specialized ER care condition was associated with significantly lower depression scores by the SA and lower maternal ratings on family cohesion. Significant interactions of intervention condition with the SA's initial level of psychiatric symptomatology indicated that the intervention's impact was greatest on maternal emotional distress and family cohesion among SA who were highly symptomatic.
Journal of Consulting & Clinical Psychology, 68(6) : 1081-3
- Year: 2000
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Controlled clinical trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Family therapy, Psychoeducation, Other service delivery and improvement interventions
Harrington, R., Kerfoot, M., Dyer, E., McNiven, F., Gill, J., Harrington, V., Woodham, A., Byford, S.
Objective: To establish whether an intervention given by child psychiatric social workers to the families of children and adolescents who had attempted suicide by taking an overdose reduced the patients' suicidal feelings and improved family functioning. Method: One hundred sixty-two patients, aged 16 or younger, who had deliberately poisoned themselves were randomly allocated to routine care (n = 77) or routine care plus the intervention (n = 85). The intervention consisted of an assessment session and four home visits by the social workers to conduct family problem-solving sessions. The control group received no visits. Both groups were assessed at the time of recruitment and 2 and 6 months later. The primary outcome measures were the Suicidal ideation Questionnaire, the Hopelessness Scale, and the Family Assessment Device. Results: There were no significant differences in the primary outcomes between the intervention and control groups at either of the outcome assessments. Parents in the intervention group were more satisfied with treatment (mean difference 1.4 [95% confidence interval 0.8 to 2.1]). A subgroup without major depression had much less suicidal ideation at both outcome assessments (analysis of covariance p < .01) compared with controls. Conclusions: The home-based family intervention resulted in reduced suicidal ideation only for patients without major depression.
Journal of the American Academy of Child & Adolescent Psychiatry., 37(5) : 512-518
- Year: 1998
- Problem: Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions